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The study of the adsorption rate of carbohydrates in the dietary intake of children and adolescents with obesity
When determined the major factors contributing to the development of obesity in children and adolescents, on the basis of the relative risk it was revealed that the activity with the computer for 3 hours or more, parental obesity and inactivity instead of walking outdoors occupied the leading position.
Thus, summarizing the results of the research should be stated that children and adolescents with obesity are characterized by hypodynamic lifestyle, going to school by transport, not going in for sports, spending much time with computer, taking meals at one and the same time, eating sweets every day as well as parental obesity and feeding the baby with formula.
Consequently, the greater activity with the computer, and parental obesity are the leading risk factors for childhood obesity.
Thus, the prevalence of obesity in the human population, a large number of complications directly related to overweight (cardiovascular, metabolic and endocrine), the heterogeneity of its forms define the search of the criteria for early diagnosis and revealing the groups at risk of developing obesity and its early metabolic complications and the implementation of preventive measures to prevent them, and therefore, to improve the quality and duration of life.
Conclusions:
1. Preventive measures for the prevention of obesity in children and adolescents should be carried out at an early age.
2. Healthy lifestyle, balanced diet, physical activity should be included in the medical care of children.
References:
1. Global Strategy on Diet, Physical Activity and Health. Report of a WHO Expert Committee. - 2012. - P. 12:4.
2. Lobykina E. N., Khvostov O. I, Koltun V Z. et al. Science and organizational approaches to the promotion of knowledge about balanced diet.//Health of the Russian Federation. - 2007. - No. 7. - P. 32-36.
3. Mamatkulov B., La Mort, Rakhmanova N. A. Clinical epidemiology. Evidence-based medicine.//manual. - Tashkent, 2011. - P. 223.
4. Mamatkulov B., Avezova G. S., Kasimova D. A. The health of children and the use of evidence-based medicine methods in the study of risk factors: Scientific-methodical manual. - Tashkent, 2011. - P. 16.
5. Pavlov N. N., Kleschina Yu. V., Eliseev Yu. Yu. Assessment of dietary intake and nutritional status of today’s children and adolescents.//Man and his health. - 2011. - No. 1. - P. 128-132.
6. Peterkova V A., Remizov O. V Obesity.//Under edit. Dedova I. I., Melnichenko G. A. - Moskow: MIA, 2004. - No. 1 -P. 315-316.
7. Sorvacheva T. N., Peterkova V. A., Titova L. N. et al. The effectiveness of a low-carb diet in the treatment of obesity in children and adolescents.//Nutrition - 2007. - Vol. 76, No. 3. - P. 29-33.
8. Florencio T. M., Ferrerira H. S., de Franca A. P. et al.//Br.J. Nutr. - 2001. - Vol. 86, No. 2. - P. 277-284.
9. Gokbel H., Atlas S.//J. Sport. Med. - 1999. - Vol. 39, No. 4 - P. 361-364.
10. Holtz C., Smith T. M., Winters F. D.//J.Am. Osteopath. Assoc. - 1999. - Vol. 99, No. 7. - P. 366-371.
11. Kinra S., Nelder R. P., Lewendon G. J.//J. Epidemiol. Commun.Hlth. - 2000. - Vol. 54, No. 6. - P. 456-460.
12. Alpes D. H., Stenson W. F., Bier D. M. Manual of nutritional therapeutics. 4th edn. - Philadelphia: Lippincott Williams and Wilkins, 2001. - Р. 644.
13. Burrows A. R., Leiva B. L., Burgue A. M., et al. Insulin sensitivity in children aged to 16 years: Association with nutritional status and pubertal development.//Rev Med. Chil. - 2006. - Р. 17-26.
14. Weker H. Simple obesity in children. A study on the role of nutritional factors.//Med. Wieku Roz-woj. - 2006. - Р. 3-19.
Rakhimov Bakhodir, Tashkent Medical Academy, assistant, the department of hygiene of children and adolescents and hygiene of nutrition E-mail: baxodir.raximov@tma.uz; rakhimov@inbox.uz
The study of the adsorption rate of carbohydrates in the dietary intake of children and adolescents with obesity
Abstract: This article aims to study the rate of adsorption of carbohydrates in the dietary intake of children and adolescents who are obese in order to develop the follow-up measures for goal-directed correction of identified eating disorders, physical activity and prevention of obesity.
Keywords: children and adolescents, body mass index, obesity, dietary intake, glycemic index.
Today obesity is one of the common chronic relaps- by WHO experts, their number will exceed up to 300 mil-
ing diseases. In 1998, it was registered 250 million obese lion. According to epidemiological studies, in world devel-
patients in the world, and in 2025, according to estimates oped countries 25 % of teenagers are overweight, and 15 %
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are obese [1, 12-44]. From all types of obesity 75 % of this disease is alimentary (exogenous-constitutional, simple) obesity [2, 128-132]. As a base of treatment of any form of obesity the rational diet therapy constitutes reducing calorie intake, the degree of which depends on the severity of obesity, age, level of physical activity and patient’s occupation [3, 3-10]. The main part in the dietary management of obesity is assigned for fats, therefore, many authors usually recommend to reduce first the amount of fat-containing products in order to decrease the caloric dietary intake of patients who are overweight [4, 388-391; 5, 971-981]. However, in addition to fat, the cause and progression of obesity is excessive dietary intake of carbohydrates. The diet therapy of obesity considers the quantitative characteristic of dietary carbohydrates and encourages to increase their intake by foods containing slowly adsorbed carbohydrates, i. e., by fruits and vegetables. Studies carried out in the 80s showed that the assimilation rate of carbohydrates depends on many factors and one of them is the chemical composition of carbohydrate-containing foods [6, 35-37]. For example, carbohydrates of baked or roasted potatoes (polysaccharides, starch) by digestion rate and the glyce-mic reaction are almost equal to glucose (monosaccharide). Carrot carbohydrates digest and cause post-alimentary gly-cemia at the same degree as the carbohydrates of most baked goods. Pasta increase blood glucose level with the same rate as the sugar. At the same time, lactose (milk sugar) is a dietary substance that contributes little to glucose.
In 1984, the group of Canadian researchers introduced the notion of “glycemic index” (GI), which reflects the adsorption rate of carbohydrates and represents the ratio of the area under the glycemia curve after consumption of 50 g. of carbohydrate in the composition of certain product to the area under the glycemia curve obtained after intake of 50 g. glucose (percentage). On the basis of these studies they asked to adjust the diet for the patients with diabetes, taking into account the data on GI carbohydrate foods [4, 388-391; 5, 971-981; 6, 35-37]. There are not summarized data on the GI of specific products in the domestic literature.
According to domestic and foreign authors foodstuffs were selected into 3 groups: with high GI (70 % or more), medium GI (40-70 %) and low GI (< 40 %) [7, 87].
At present time, GI does not take into account in the diet of patients with overweight and obesity at all. Typically, doctors recommend these patients to increase the amount of fruits and vegetables in the diet without taking into account their GI. Common and prevailing fruits and vegetables (potatoes, carrots, beets, bananas, raisins, etc.) have high GI, so that they, as well as bakery products from flour, sweet drinks and pastries, can raise insulin level in blood (subject to insulin metabolism) without providing any feeling of satiety, promoting overeating. Therefore, when drawing up the diet for patients with overweight and obesity it is necessary to achieve the selection of carbohydrate-containing foods with a certain GI. This object is achieved by the prescribed low
calorie diet, which mainly includes carbohydrate foods with GI < 40 % [6, 35-37; 7, 87].
Carbohydrate foods with low GI are vegetables, fruits, berries, as well as cereals and products of wheat flour, which are based on cellulose and vegetable fibers. Should be considered that cellulose is hardly absorbed by the body, however, filling the stomach, it creates a feeling of satiety. Foods that rich in cellulose contain many vitamins, and so the water that does not add calories but fills the stomach. Therefore, it is possible to achieve a stable weight loss due to the fact that products with low GI (because of the high content of dietary fibers) do not give marked burden on the insular apparatus. In addition, they provide enhanced gastric fullness, normalizing the appetite.
Aim: to study the adsorption rate of carbohydrates (glycemic index) in the dietary intake of children and adolescents with obesity.
It was examined 28 girls and 26 boys aged 11 to 15 years, diagnosed with exogenous constitutional obesity I, II and III degree. During outpatient survey they estimated nutritional status, as well as health, activity and mood of patients. The actual nutrition in children and adolescents was studied using a map-based questionnaire. Collection of material was carried out in expeditionary conditions, 2 times a year (winter-spring and summer-autumn periods) with registration in the individual sheets factual products eaten by children and adolescents for 6 days.
The content of basic nutrients and energy was calculated from the chemical composition tables of food (8). The magnitude of the absorption rate of carbohydrates — glycemic index in the dietary intake of children and adolescents were calculated by E. H. Lobykina table et al. [9, 14-21].
Obtained results were compared with average daily norms of rational consumption of food for the population of Uzbekistan (sanitary norms and rules (SanNandR) № 0105-01 and № 0250-08) [10, 25; 11, 38]. The data were subjected to statistical analysis on the computer Intel Core i7, Microsoft Office 2013 [12, 143].
Results
According to the questionnaire, the diet of children with obesity was characterized by the predominance of bread, flour, cereals and confectionery. The high content of saturated fats, salt and sugar in the diet against the background of not doing food standards for fresh fruits and vegetables (deficiency of dietary fibers in the diet being 80 %) was noted. In the main group the content of meat and meat products (sausages, frankfurters, etc.) in the diets were significantly higher than normal. During a week, teenagers with obesity were eating fast food (hamburger, hot dog, French fries, etc.) without limitation. Calculations of children diets showed that excess consumption of meat and meat products in children aged 11 to 15 years was 12.1 % in the winter-spring period, 8 % — in the summer and autumn period, but in the control group there is a shortage of these products on the 1.3 and 2.75 % (Table 1).
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The study of the adsorption rate of carbohydrates in the dietary intake of children and adolescents with obesity
Table 1. - The average range of staple foods in diets of children and adolescents aged 11-15 years
Products, g. * Norm, g. Children and adolescents with obesity Children anc with hormonal 1 adolescents physical growth
Winter and spring period Summer and autumn period Winter and spring period Summer and autumn period
Meat and meat products (in terms of meat) 150 169 (112.7) 162 (108.0) 148 (98.7) 140 (93.3)
Milk and dairy products (milk equivalent) 491 480 (97.8) 420 (85.5) 410 (83.5) 380 (77.4)
Fish and fish products 35 25 (71.4) 22 (62.9) 19 (54.3) 16 (45.7)
Eggs (piece) 1.0 0.9 (90) 0.8 (80) 0.8 (80) 0.7 (70)
Bread and bakery products (in terms of bread) 314 495 (157.6) 443 (141.1) 427 (136.0) 398 (126.8)
Potatoes 181 238 (131.5) 221 (122.1) 215 (118.9) 196 (108.3)
Animal fat 21 30 (142.9) 28 (133.3) 19 (90.5) 16 (76.2)
Vegetable oil 16 18 (112.5) 17 (106.3) 15 (93.8) 14 (87.5)
Vegetables and melons 296 250 (84.5) 300 (101.4) 275 (92.9) 318 (107.4)
Fruits and berries 325 230 (70.8) 340 (104.6) 245 (75.4) 330 (101.5)
Sugar and confectionery (in sugar) 67 85 (123.2) 76 (110.1) 70 (101.4) 65 (98.5)
Note: * — When preparing the table the recommended range and the number of products per day by (SanNandR) № 0105-01 and № 0250-08 has been taken into account
Dairy products like milk, cheese, sheep cheese and cottage cheese were explicitly deficient; the range of these products mainly includes yogurt, kurt (product of salty curd), kaimak (clotted cream), sometimes sour clotted milk, especially in winter-spring period, and respectively were lower to recommended standards; the deficit ranged from 39.2 % to 45.0 %, and in summer-autumn period from 29.8 to 37 %. In the control group the above products cottage cream, kurt were not identified in the diet, but milk and dairy products were lower the standards by 16.6 and 22.6 %, as well. Fish and fish products were used very rarely. Deficiency of vegetable fat was relatively little. Butter, lamb and beef were used as animal fat. The obvious lack (about 2 times less than the norm) of the consumption of vegetables, melons, fruits and berries was found in children with obesity and in control group. Fried potatoes seemed to be a favorite dish for the every third surveyed, especially in boys, which exceeded the norm by 30 and 22 %, in the control group was also higher than the norm by 18 and 8 %. Sugar and confectionery were higher on 23 and 10 % in the main group and in the control group on 1.4 % in the winter and spring period, but in summer period the lack was 1.5 %. Analysis of collected data showed that the energy value of nutrition of school children with obesity was on 27 % higher than in the control group, due to excessive consumption of high-calorie foods: saturated fat, salt and sugar, as well as baked goods. The calculation of biological value of the diets of children and adolescents with obesity showed that the content of total protein was 1.2 and 1.4 % higher than normal. In the control group, in winter-spring period protein deficiency was 4.7 %, and in summer-autumn period — 2.2 %. The animal fats which amounted to 66.5 ± 1.3 by 6.7 % dominated in the diet above normal in winter-spring period, 62.7 ± 2.1 by 10 % above normal in summer and autumn period. In the control
group 51.5 ± 1.7 (9.6 %) and 50.8 ± 1.2 (8.2 %) was lower than normal. As compared to the control group in children and adolescents with obesity the animal protein intake was significantly prevailed (P > 0.001).
The fat content in the daily diet exceeded the physiological norm by 30.8 and 20 %, while in the control group it was lower the norm by 3.7 and 2.2 %. The optimal ratio of fat consumption of plant and animal origin is the content of animal fat in the daily diet at least 21 %, and plant more than 16 %. The animal fats dominated in the diet, they amounted to 121.6 ± 4.2 (130.8) in the winter-spring period and 111.6 ± 4.9 (120.0) in the summer and autumn. The level of animal fat consumption was significantly different from that in the control group and was 1.2 times higher (P > 0.001). In the comparable groups of children the excess amount of carbohydrates in actual food rations was noted: in obese children by 32.5 and 25 % and in the control group by 3 of 10 %. There found the high content of mono- and disaccharides in daily diet, specified by accessibility for children with obesity to high-calorie confectionery and pantry products (crackers, nuts, cookies, popcorn, etc.). Therefore, in comparison with the control group in 58.9 % of obese children the consumption of carbohydrates was significantly more prevalent.
Based on these data, it was found that the excess of daily caloric content achieved due to the excess of dietary fat and carbohydrates. Wherein the ratio of the macronutrients was 1 : 1.5 : 5.5 at a rate of 1 : 1 : 4.
On estimation the micronutrients in the daily diet it was revealed the following: in the main group the calcium content was recorded rather higher than normal (4 and 5 %); and in the control group was lower the norm by 28.4 %, 1.1 times was higher than the recommended daily levels of magnesium, probably due to excess cereals, and in the control group
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was lower normal by 21 and 17 %; the phosphorus content was normal, and in the control group was lower the norm by 17.8 and 19.8.
In assessing the micronutrients in the daily diet it was revealed the iron deficiency that was 13.3 ± 2.4 and 13.8 ± 2.8 mg/day in obese children, but 12.6 ± 2.9 and 13.1 ± 2.1 mg/day in the control group, at the appropriate level was 16.5 mg.
Analysis of the daily intake of vitamins in obese children showed the reduction for normal intake of vitamins A, E and C, and their combined use, as it is known, is a powerful antioxidant factor [3, 3-10]. The content of vitamin A in the diets of obese children was lower than normal in winter-spring period by 53.3 %, in summer-autumn period by 47.8, 62.0 and in the control group 62.0 and 58.0. The content of vitamin Bx in obese children exceeded the norm by 41.7 and in the control group 33.3 %; vitamin B2 was lower than normal by 1.2-1.5 times (29 %), while in the control group to 1.5 times (28.5 %).
The content of vitamin PP in the diets of the main group was higher than normal at 10 and 5 % and in the control group was lower at 7.6 and 4 %. They established the reduced indicators of vitamin C. Our studies showed that the deficiency of vitamin C (ascorbic acid) in the body of obese children ranged from 20 to 22.5 %, and in control group up to 20.0 %.
After studying the actual nutrition of children and adolescents, we studied the glycemic index of some foods that were above normal. On average, the children consumed 237.2 + 0.7 g. (instead 65.5 g.), 43.3 % higher than normal bakery products from extra flour: wheat bread from extra flour 120 g., GI of one portion is 25 g., 95 %; bakery products — loaves 100 g., 85 %; ice-cream 120 g., GI of one portion is 60.0 g., 70 %; corn flakes, sticks 137 g., GI of one portion is 12 g., 70-85 %; potatoes 238 g., GM is 181 g. per serving, 95 %; 85 g. sugar, GI is 60 %. Children consumed fruits and berries, especially in summer time, that exceeded the normal of fruits and berries,
raisins have high GI (70 %). Vegetables and melons, included in the dietary intake, were lower the standards that have low GI (less than 40 %), based on cellulose and fibers. In the control group for the above products GI lower than 40 %.
As indicated above, the nutritional products are distributed into three groups: those with high (70 % or more), medium (40-70 %) and low (less than 40 %). The children and adolescents with obesity examined by us had the value of GI, reflecting the absorption rate of carbohydrates in the dietary intake of many foods is high. The current level of nutrition needs clear recommendations on the number and qualitative composition of carbohydrate-containing products, which differ in the rate of absorption.
It should be noted that fruits and vegetables: potatoes, carrots, beets, bananas, raisins, watermelon, etc., have high GI, so that, as well as bakery products from extra flour, sweet drinks and pastries, they can raise insulin levels in the blood and do not provide long-term satiety, contributing to overeating [9, 14-21].
Thus, analysis of the nutrition of children with obesity showed not only qualitative and quantitative inferiority, but not adjustable to hygienic standards in almost all parameters. The diet and bakery products, as well as some fruits and vegetables have high GI, which exceed the norms by 20-30 %. More pronounced imbalance in their nutrition is a significant risk factor for children and adolescents of functional disorders and it requires the obligatory correction.
Conclusions:
1. The actual nutrition is inadequate for the expenditure of energy in the side of their excess is characterized by high level of fats and carbohydrate consumption and are not fully adequate for the content of vegetable fats, polysaccharides, cellulose, some vitamins (A, E and C) and minerals (iron).
2. The diet and bakery products, as well as some carbohydrate-containing foods have high GI, which reflect the rate of absorption of carbohydrates.
References:
1. Global Strategy on Diet, Physical Activity and Health. Report of WHO Expert Committee. - 2012. - P. 12-44.
2. Pavlov N. N., Kleschina Yu., Eliseev Y. Y. Assessment of dietary intake and nutritional status of today’s children and ado-lescents.//Man and his health. - 2011. - № 1. - P. 128-132.
3. Shayhov G. I., Rakhimov B. B. Prevention of obesity in children and adolescents./Guidelines - 2010. - P. 3-10.
4. Jenkins D. J. A., Wolewer T. M. S., Jenkins A. L.//Lancet. - 1984. - Vol. 2. - P. 388-391.
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6. Kasatkina E. P., Odud E. A.//Probl. endocrinol. - № 6. - P. 35-37.
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8. Chemical composition of foods: Manual/Ed. Corresponding Member. MIA, prof. Skurikhina I. M. and Acad. of Medical Sciences, prof. Tutelian V. A. - M.: print Delhi, 2002. - P. 236.
9. Lobykina E. N., Koltun V. Z., Hvostova O. I. The glycemic index of foods and its use in the dietary management of obe-sity.//Nutrition. - 2007. - Vol. 76, № 1. - P. 14-21.
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01. -2001. - P. 25.
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